Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 73 , Issue 3
Showing 1-40 articles out of 40 articles from the selected issue
Circulation Journal Award of the Year 2008
Reviews
  • Attilio Maseri, John F Beltrame, Hiroaki Shimokawa
    2009 Volume 73 Issue 3 Pages 394-403
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 06, 2009
    JOURNALS FREE ACCESS
    Atherothrombosis has long been recognized as an important mechanism of cardiac events in ischemic heart disease, and large multicenter clinical studies have shown the benefit of antiplatelet agents, statins, β-blockers and angiotensin converting enzyme inhibitors in preventing these events. However, more recent studies have been less successful at showing incremental gains in targeting these mechanisms, suggesting that the limits of this strategy have been exploited. Coronary vasoconstriction is another important mechanism in ischemic heart disease but has received little attention and yet is a potential therapeutic target. In the current review, the reasons why coronary vasconstriction has received insufficient consideration are explored. In particular, we need to change our approach from lumping heterogeneous clinical entities together to focusing on clinically-discrete homogeneous groups with a common mechanism and thus therapeutic target. The role of coronary vasoconstriction is examined in the various ischemic syndromes (variant angina, chronic stable angina, acute coronary syndromes and syndrome X) and the underlying mechanisms discussed. Finally, in order to advance studies in this field, an innovative research strategy is proposed, including: (1) selection of paradigmatic cases for the various ischemic syndromes; (2) candidate therapeutic targets; and (3) approaches in assessing the clinical efficacy of these potential therapies. (Circ J 2009; 73: 394 - 403)
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  • What is Known and Unknown
    Kazuhiro Yamamoto, Yasushi Sakata, Tomohito Ohtani, Yasuharu Takeda, T ...
    2009 Volume 73 Issue 3 Pages 404-410
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 04, 2009
    JOURNALS FREE ACCESS
    There is an emerging interest in heart failure with preserved ejection fraction (HFPEF) because of its high prevalence in the community and several specific characteristics compared with "classic" heart failure with reduced ejection fraction. HFPEF patients are older and more often female, and lack left ventricular dilatation. A likely principal cause of HFPEF is diastolic dysfunction, particularly ventricular stiffening; however, the clinical phenotype of HFPEF is also modulated by dysfunction of other organs such as kidney, vasculature, etc. Despite its social burden, the diagnostic criteria and therapeutic strategies remain to be established. In particular, the lack of established diagnostic criteria has resulted in conceptual confusions about HFPEF in clinical practice. In this review, what is known and unknown about HFPEF is discussed, and several challenging proposals about its diagnosis and therapy are raised. (Circ J 2009; 73: 404 - 410)
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  • Yukihito Higashi, Kensuke Noma, Masao Yoshizumi, Yasuki Kihara
    2009 Volume 73 Issue 3 Pages 411-418
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 04, 2009
    JOURNALS FREE ACCESS
    The vascular endothelium is involved in the release of various vasodilators, including nitric oxide (NO), prostacyclin and endothelium-derived hyperpolarizing factor, as well as vasoconstrictors. NO plays an important role in the regulation of vascular tone, inhibition of platelet aggregation, and suppression of smooth muscle cell proliferation. Endothelial dysfunction is the initial step in the pathogenesis of atherosclerosis. Cardiovascular diseases are associated with endothelial dysfunction. It is well known that the grade of endothelial function is a predictor of cardiovascular outcomes. Oxidative stress plays an important role in the pathogenesis and development of cardiovascular diseases. Several mechanisms contribute to impairment of endothelial function. An imbalance of reduced production of NO or increased production of reactive oxygen species, mainly superoxide, may promote endothelial dysfunction. One mechanism by which endothelium-dependent vasodilation is impaired is an increase in oxidative stress that inactivates NO. This review focuses on recent findings and interaction between endothelial function and oxidative stress in cardiovascular diseases. (Circ J 2009; 73: 411 - 418)
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  • Hiroyuki Watanabe, Manabu Murakami, Takayoshi Ohba, Kyoichi Ono, Hiros ...
    2009 Volume 73 Issue 3 Pages 419-427
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 06, 2009
    JOURNALS FREE ACCESS
    Transient receptor potential (TRP) channels are expressed in almost every human tissue, including the heart and vasculature. Most are permeable to Ca2+ and play unique roles as multifunctional cellular sensors. Their involvement in many fundamental cell functions (eg, contraction, proliferation, and cell death) has made investigating their roles in human disease an urgent priority for medical science. This review presents an overview of current knowledge about the pathological role of TRP channels in heart disease and highlights some TRP channels with anticipated roles in disease. Evidence suggests that (a) upregulation of TRPC channels is involved in the development of cardiac hypertrophy and heart failure; (b) TRPC1, TRPC6, and TRPV2 play a role in the pathogenesis of cardiomyopathy associated with muscular dystrophy; (c) TRPC6 or TRPM4 is involved in the delayed after-depolarization; (d) TRPP2 is involved in the normal development of the interventricular and interatrial septa; and (e) neuronal TRPV1 acts as a detector of pain-producing stimuli. Ultimately, TRP channels might become novel pharmacological targets in the treatment of human heart disease. (Circ J 2009; 73: 419 - 427)
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Editorials
Original Articles
Arrhythmia/Electrophysiology
  • Ri-Bo Tang, Jian-Zeng Dong, Xing-Peng Liu, De-Yong Long, Rong-Hui Yu, ...
    2009 Volume 73 Issue 3 Pages 438-443
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 28, 2009
    JOURNALS FREE ACCESS
    Background: Metabolic syndrome (MetS), as well as several risk factors of cardiovascular diseases, is known to be associated with atrial fibrillation (AF), but its impact on the recurrence of AF after catheter ablation has not been explored. Methods and Results: The data for 654 consecutive AF patients who underwent an index circumferential pulmonary vein ablation were retrospectively analyzed. Of them, 323 (49.4%) had MetS according to the modified National Cholesterol Education Program-Adult Treatment Panel III criteria and Chinese ethnic criteria. After a mean follow-up of 470±323 (91-1,245) days, patients with MetS had a significantly higher incidence of AF recurrence (43.7%) compared with non-MetS patients (30.5%, P<0.001). Univariate analysis revealed that nonparoxysmal AF, left atrial size, MetS and body mass index were predictors of AF recurrence. Multivariate analysis revealed that MetS (hazard ratio =1.64, 95% confidence interval (CI) 1.07-2.49, P=0.022) and nonparoxysmal AF (hazard ratio =1.57, 95% CI 1.15-2.14, P=0.004) were independent predictors of AF recurrence. The major complications rate did not differ between the MetS and the non-MetS groups (1.86% vs 2.42%, P=0.621). Conclusions: MetS diagnosed prior to AF ablation is an independent predictor of AF recurrence. (Circ J 2009; 73: 438 - 443)
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  • Based on Anatomic Properties
    Sen Lei, Bo Zhang, Jinjin Wu, Zengzhang Liu, Bernhard Zrenner, Yuehui ...
    2009 Volume 73 Issue 3 Pages 444-450
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 30, 2009
    JOURNALS FREE ACCESS
    Background: The electrophysiological characteristics of the Marshall potential is important in ligament of Marshall (LOM) ablation. Methods and Results: Marshall potential was recorded under sinus rhythm and left atrial appendage (LAA) pacing and in the first randomly selected 5 dogs (Group 1), LOM ablation was performed. Histological examination was performed in the remaining 10 dogs, which were subdivided according to the results (Groups 2, 3). During LAA pacing in Group 2, the AM interval was prolonged or shortened, whereas in Group 3 it was prolonged (125±9 vs 80±6 ms, P=0.043, when the pacing rate =350) (126±9 vs 80±6 ms, P=0.0442, when the pacing rate =450). The Marshall potential was separated from the atrial electrogram by LAA pacing in Groups 2 and 3. There was no significant difference in the AM interval during sinus rhythm and right atrial appendage pacing. Conclusions: Marshall potential has different forms on electrograms, including a prolonged AM interval, which presents with LAA pacing. This finding might be useful in LOM ablation. (Circ J 2009; 73: 444 - 450)
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  • Takeshi Aiba, Wataru Shimizu, Takashi Noda, Hideo Okamura, Kazuhiro Sa ...
    2009 Volume 73 Issue 3 Pages 451-460
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 28, 2009
    JOURNALS FREE ACCESS
    Background: Intra-atrial reentrant tachyarrhythmia (IART) after surgical repair for congenital heart diseases (CHD) has not been noninvasively characterized. Methods and Results: The 28 patients after surgery for CHD and 14 patients without surgery were investigated by 87-lead body surface mapping (BSM), 12-lead electrocardiogram (ECG), 20-lead signal averaged ECG (SAECG) and endocardial electroanatomical mapping (CARTO) during clockwise (CW: n=9) or counterclockwise (CCW: n=5) incisional atrial tachycardia (Incision-AT), CCW (n=23) or CW (n=4) cavotricuspid isthmus-dependent atrial flutter (CTI-AFL), and double-loop reentry (n=4). On the BSM, the isopotential map pattern and its locus of the minimum potential could differentiate the reentrant circuits, and the activation map revealed the reentrant circuits, which were highly coincident with those obtained from CARTO. On the 12-lead ECG, negative-positive polarity in the inferior leads or a discordant pattern in the precordial leads was observed in all cases of CTI-AFL, but 3/14 Incision-AT, positive polarity in lead V1 was observed in all cases of CCW, but none of CW CTI-AFL, positive polarity in lead I was observed in all cases of CW, but none of CCW Incision-AT. Conclusions: Flutter-wave isopotential map and its activation sequence from the BSM predict reentrant circuits of IART after surgery for CHD. Flutter-wave polarity on the 12-lead ECG could differentiate these reentrant patterns. (Circ J 2009; 73: 451 - 460)
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  • Katja E. Odening, Jeanne M. Nerbonne, Christoph Bode, Manfred Zehender ...
    2009 Volume 73 Issue 3 Pages 461-467
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 15, 2009
    JOURNALS FREE ACCESS
    Background: Gain-of-function K+ channel mutations cause familial atrial fibrillation (AF) by shortening of the atrial action potential duration (APD). APD-prolonging K+ channel blockers are an effective therapeutic option in AF. In vitro, the dominant negative Kv4.2W362F mutation (Kv4DN) eliminates Ito,f in murine atrial myocytes and markedly prolongs the APD, so whether this loss-of-function of Ito,f alters the atrial effective refractory period (AERP) in vivo and/or affects AF-inducibility was investigated in the present study. Methods and Results: Transvenous electrophysiological studies were performed in vivo in Kv4DN and wild-type littermate control (LMC) mice. Intriguingly, no difference was found between Kv4DN and LMC for the AERP in vivo either at baseline or after carbachol. Consequently, AF-inducibility at baseline (Kv4DN: 10/16 vs LMC: 7/13) and after carbachol (Kv4DN: 9/16 vs LMC: 6/13) did not differ between groups. However, AF-inducibility was associated with a significantly shorter AERP (inducible 51.1 ±1.4 vs non-inducible 58.4 ±1.6; P<0.01) irrespective of genotype. Conclusions: The loss-of-function of Ito,f prolongs the APD in mouse atrial myocytes in vitro, but this effect on single cells does not translate into measurable AERP prolongation in vivo and hence does not exert an anti-arrhythmic effect. However, the susceptibility of mice to AF in vivo is determined by the individual AERP, irrespective of genotype. (Circ J 2009; 73: 461 - 467)
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  • Toshiyuki Furukawa, Kenzo Hirao, Tomoe Horikawa-Tanami, Hitoshi Hachiy ...
    2009 Volume 73 Issue 3 Pages 468-475
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 16, 2009
    JOURNALS FREE ACCESS
    Background: The role of autonomic effects in the occurrence and maintenance of atrial fibrillation (AF) has undergone little investigation in the remodeling heart. Methods and Results: In the present study, 2 groups were studied: those with complete atrioventricular block (AVB) produced by radiofrequency current application (AVB dogs, n=17) and those not undergoing AVB (sham dogs, n=5). Eight weeks after creation of AVB, electrophysiologic study, including pulmonary vein (PV) pacing for AF induction, was performed under vagal nerve stimulation (VNS) and sympathetic stimulation (SS) in both groups. After 8 weeks, atrial dimensions and the percentage of fibrosis in the atria were significantly greater in the AVB dogs. In AVB dogs, atrial and PV effective refractory periods were shorter (P<0.01), and atrial conduction velocity increased (P=0.01) during SS, but not during VNS. Inducibility of AF increased only during SS in the AVB dogs (sustained AF: control 7%, SS 60%; P=0.005), whereas it increased only during VNS in the sham dogs. Conclusions: In the remodeled atria, sympathetic stimulation was crucial for the genesis of AF, which is completely different from the condition in normal atria. (Circ J 2009; 73: 468 - 475)
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Cardiac Rehabilitation
  • Anna Jegier, Anna Jegier, Katarzyna Szmigielska, Maria Bilinska, Lecho ...
    2009 Volume 73 Issue 3 Pages 476-483
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 29, 2009
    JOURNALS FREE ACCESS
    Background: The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD). Methods and Results: The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in both settings of CR according to EQ-5D and SF36 results. Health status was improved by 11.1% in the RCR group and by 10.4% in the ACR group. Last workload's intensity increased significantly by 32.1% in the RCR group and by 38.1% in the ACR group. The rate of perceived exertion intensity did not change despite the bigger workloads during the exercise test. Conclusions: Comprehensive CR improves health-related QOL and exercise capacity without differences between residential and ambulatory models. (Circ J 2009; 73: 476 - 483)
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Critical Care
  • Naoki Nakayama, Kazuo Kimura, Tsutomu Endo, Kazuki Fukui, Hideo Himeno ...
    2009 Volume 73 Issue 3 Pages 484-489
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 15, 2009
    JOURNALS FREE ACCESS
    Background: The door-to-balloon time (DTB) is an important predictor of the outcome for patients with ST-elevation myocardial infarction (STEMI). In Japan, percutaneous coronary intervention (PCI) can be performed at many hospitals, and the predominant strategy for reperfusion therapy is primary PCI. However, it remains unclear how rapidly reperfusion is achieved at these hospitals. Methods and Results: The study group comprised 369 patients with STEMI who presented within 12 h of symptom onset to a tertiary emergency center (TEC) or at 11 community hospitals (CHs) in 2006 and underwent emergency coronary angiography. Median DTB was shorter in the TEC (63 vs 104 min, P<0.001), and the rate of DTB within 90 min was higher in the TEC (96% vs 39%, P<0.001). Lateral myocardial infarction, presentation during off-hours, and non-cardiologist as the first-contact physician were significantly associated with a prolonged DTB in CHs. There was a trend toward lower 30-day mortality from all causes in the TEC (2.0% vs 4.8%, P=0.08). Multiple logistic regression analysis demonstrated that prolonged DTB (>90 min) was an independent predictor of 30-day mortality (odds ratio 12.6; 95% confidence interval 1.85-86.2, P=0.01). Conclusions: Establishment of emergency cardiac care systems with the goal of DTB within 90 min is required in PCI-capable hospitals to improve clinical outcomes. (Circ J 2009; 73: 484 - 489)
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  • SOS-KANTO study group
    2009 Volume 73 Issue 3 Pages 490-496
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 04, 2009
    JOURNALS FREE ACCESS
    Background: Focusing on the efficacy of successful ventilation during cardiopulmonary resuscitation (CPR) with alternative airways, previous reports investigated various parameters such as success rate, tidal volume, incidence of regurgitation, etc. However, there are few investigations of arterial blood gases (ABG) during CPR with alternative airways, especially the laryngeal mask airway (LMA). Methods and Results: A prospective multicenter study, non-randomized control trial compared ABG on hospital admission of patients resuscitated by emergency medical service personnel with a bag-valve-mask (BVM) with those using a LMA in witnessed cardiac-verified out-of-hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia. According to the Utstein template, 173 cases of LMA and 200 of BVM both placed by paramedics were enrolled. The median arterial pH was statistically higher in the LMA group than in the BVM group (7.117 vs 7.075, P=0.02). There was no difference in the median value of PaCO2 (52.9 vs 55.3, P=0.06) and PaO2 (64.6 vs 71.9, P=0.56). Conclusions: LMA does not greatly benefit the respiratory status of patients such as in this study population. Delayed placement of a LMA will be recommended to achieve minimally interrupted chest compression in an out-of-hospital CPR protocol for witnessed VF cases following shock. (Circ J 2009; 73: 490 - 496)
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Imaging
  • Masanori Yamamoto, Masamichi Takano, Kentaro Okamatsu, Daisuke Murakam ...
    2009 Volume 73 Issue 3 Pages 497-502
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 16, 2009
    JOURNALS FREE ACCESS
    Background: Thin cap fibroatheroma (TCFA) is considered to be a vulnerable plaque. Virtual Histology-intravascular ultrasound (VH-IVUS) can precisely identify TCFA in vivo. Intense yellow plaque on angioscopy determined by quantitative colorimetry with L*a*b* color space corresponds with histological TCFA; in particular, a plaque of color b* value >23 indicates an atheroma with a fibrous cap thickness <100 μm. In the present study, the relationship between VH-TCFA and angioscopic plaque color determined by colorimetry was investigated. Methods and Results: Fifty-seven culprit plaques in 57 patients were evaluated by VH-IVUS and angioscopy. VH-TCFA was defined as a plaque with a necrotic core >10% of plaque area without overlying fibrous tissue, and angioscopic TCFA was a plaque with b* value >23. The frequency of angioscopic TCFA was higher in the VH-TCFA group than in the VH-non-TCFA group (74% vs 23%, P=0.0002). Moreover, yellow color intensity (b* value) significantly correlated with plaque classification on VH-IVUS. When TCFA detected with angioscopy was used as the gold standard, the sensitivity, specificity, and accuracy for TCFA with VH-IVUS was 68%, 81%, and 75%, respectively. Conclusions: VH-TCFA strongly correlated with angioscopic TCFA determined by a quantitative analysis with colorimetry. (Circ J 2009; 73: 497 - 502)
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Ischemic Heart Disease
  • Correlation With Left Ventricular Remodeling
    Hideyuki Kondo, Yukihiro Hojo, Rie Tsuru, Yoshioki Nishimura, Hayato S ...
    2009 Volume 73 Issue 3 Pages 503-507
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 15, 2009
    JOURNALS FREE ACCESS
    Background: Apoptosis is reported to play an important role in left ventricular (LV) remodeling after acute myocardial infarction (AMI). Granzyme B is a member of the serine esterase family, which has an important role in cellular apoptosis and extracellular matrix degradation. Methods and Results: Peripheral blood samples were obtained from 33 patients with a first-onset AMI treated by percutaneous coronary intervention (mean age: 61.4±8.7 years old) on days 1, 7 and 14 after onset. Plasma levels of tumor necrosis factor (TNF)-α, a soluble form of the Fas ligand (sFasL), and granzyme B were measured. TIMI grade 3 recanalization was accomplished in all patients within 12 h after onset. The LV end-diastolic volume index (LVEDVI) was calculated on day 1 and at 6 months after onset. Plasma levels of TNF-α, sFasL and granzyme B increased significantly on days 7 and 14 after onset of AMI. Stepwise multivariate regression analysis showed that the plasma granzyme B level on day 14 is a significant explanatory variable for changes in the LVEDVI. Conclusions: Plasma levels of granzyme B increased after AMI, which might be an important factor in the progression of late LV remodeling after AMI. (Circ J 2009; 73: 503 - 507)
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  • Hideki Kitahara, Yoshio Kobayashi, Hideo Takebayashi, Yoshitake Nakamu ...
    2009 Volume 73 Issue 3 Pages 508-511
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 16, 2009
    JOURNALS FREE ACCESS
    Background: Large-scale randomized trials demonstrate a high proportion of focal restenosis after drug-eluting stent (DES) implantation. On the other hand, recent reports have shown that in real-world practice a significant proportion of the restenosis is non-focal when DESs are used in unselected lesions. The present study evaluated angiographic patterns of restenosis after sirolimus-eluting stent (SES) implantation in Japan. Methods and Results: Angiographic restenosis patterns of all consecutive restenotic lesions (n=124) after SES implantation were evaluated and classified according to the following scheme: focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent), and occlusive. There were 98 focal (79.0%), 15 diffuse (12.1%), and 5 proliferative restenoses (4.0%) and 6 total occlusions (4.8%). Focal intrastent restenosis was most dominant (42.7%). Proximal edge restenosis occurred in 22 lesions (17.7%). Multivariate analysis demonstrated diabetes mellitus (P<0.01) as an independent predictor of non-focal restenosis. Conclusions: Focal restenosis is predominant after SES implantation in real-world practice in Japan. (Circ J 2009; 73: 508 - 511)
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  • Takayuki Ogawa, Kimiaki Komukai, Kazuo Ogawa, Tsuneharu Kosuga, Tomohi ...
    2009 Volume 73 Issue 3 Pages 512-515
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 03, 2009
    JOURNALS FREE ACCESS
    Background: Calcium-channel blockers (CCBs) are highly effective in suppressing coronary spasm and are widely used as the standard therapy for coronary spastic angina, but it is unclear if CCB treatment completely suppresses the symptoms. Methods and Results: The clinical course of the symptoms caused by coronary spasm was investigated in patients taking CCBs: 90 patients were evaluated and 80 patients were followed. The mean follow-up period was 1,796±1,169 days. There were no cardiac deaths, but 3 patients were admitted to the hospital, 1 because of the onset of non-Q wave myocardial infarction and 2 because of repeat anginal attacks. In those 2 patients, medical therapy was discontinued at their discretion. In the follow-up analysis, we found that the incidence of symptoms caused by repeat anginal attacks was 37.0% (27/73) in the first year and was increasing every year. Conclusions: CCBs are strongly recommended for improving the prognosis of coronary spasm, but in many cases they do not suppress completely symptoms. (Circ J 2009; 73: 512 - 515)
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Pediatric Cardiology
  • 18-Year Clinical Experience and Angiographic Follow-up of Major Aortopulmonary Collateral Arteries
    Suk-Won Song, Han Ki Park, Young-Hwan Park, Bum Koo Cho
    2009 Volume 73 Issue 3 Pages 516-522
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 28, 2009
    JOURNALS FREE ACCESS
    Background: There is no consensus on the long-term outcome after unifocalization in patients undergoing surgery for pulmonary atresia with ventricular septal defects (VSD) and major aortopulmonary collateral arteries (MAPCAs). Methods and Results: From 1988 to 2006, 40 patients (median age 8.5 months) underwent surgery for pulmonary atresia, VSD, and MAPCAs. The hospital mortality rate for the preparatory procedures was 1.2%; 17 patients had a complete repair (CR) at a median age of 3 years. Patients with a pulmonary artery index greater than 100 mm2/m2 had a higher likelihood of CR. The overall survival rate 15 years after first operation in the CR group was 87.5%. Cox analysis demonstrated that increased number of MAPCAs (P=0.019, HR=1.666) was a significant predictor of poor survival, and CR (P=0.025, HR=0.141) was a significant predictor of favorable prognosis. On angiography, serial measurements of MAPCAs showed a significant decrease in size (from 5.2±2.9 to 4.1±2.9 mm after a mean of 20 months) (P<0.0001). Conclusions: Long-term survival into adulthood can be achieved with an integrated approach. Late survival depends on the number of MAPCAs, and CR. Growth potential of unifocalized MAPCAs was not definite. (Circ J 2009; 73: 516 - 522)
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Pulmonary Circulation
  • Sequence of Changes in Hemodynamic Effects
    Masahito Sakuma, Jun Demachi, Jun Nawata, Jun Suzuki, Tohru Takahashi, ...
    2009 Volume 73 Issue 3 Pages 523-529
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 29, 2009
    JOURNALS FREE ACCESS
    Background: Sequential changes in the hemodynamic effect of chronic epoprostenol therapy raise the following questions. Does an increase in cardiac output (CO) precede lowering of the pulmonary artery pressure (PAP) over the time course of improvement? What are the characteristics of good responders to chronic epoprostenol treatment? Methods and Results: Hemodynamics were evaluated by catheter examination. Most patients still alive after >1 year showed an increase in CO either with no change in mean PAP or accompanied by a decrease in mean PAP during increased dosing of epoprostenol. Immediately before cessation of the increase in epoprostenol dose in good responders, the ratio of total pulmonary resistance to total systemic resistance was low, and the pulmonary artery wedge pressure minus right atrial pressure was high compared with the newest data in poor responders. One year after fixing at the best dose of epoprostenol, the mean PAP further decreased. Conclusions: In good responders, pulmonary selectivity to epoprostenol is high, and the blood returning to the left-sided heart through the pulmonary circulation increases. Hemodynamics further improve, even after fixing at the best dose of epoprostenol. The present data did not show that an increase in CO precedes lowering of the PAP over the course of improvement. (Circ J 2009; 73: 523 - 529)
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Stroke
  • Michiya Igase, Yasuharu Tabara, Keiji Igase, Tokihisa Nagai, Namiko Oc ...
    2009 Volume 73 Issue 3 Pages 530-533
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 16, 2009
    JOURNALS FREE ACCESS
    Background: Cerebral microbleed (CMB), which is conspicuous on gradient-echo T2*-weighted magnetic resonance imaging, is a risk factor of intracerebral hemorrhage (ICH). CMBs have been detected even in neurologically healthy persons, who also seem prone to be affected by stroke, not only ICH but also cerebral infarction. Methods and Results: The presence of CMB was investigated in brain dock participants, making reference to silent lacunar infarction (SLI). Participants comprised 377 neurologically healthy persons and 21 (5.6%) had CMB detected, which was associated with a high incidence of hypertension, other conventional risk factors having no significant correlation with CMB. In a simple correlation analysis, CMB showed a positive association with age and systolic blood pressure (SBP). Logistic regression analysis revealed that SLI was the factor most strongly associated with CMB. Moreover, individuals who had both CMB and SLI had higher SBP than other groups. Conclusions: The etiology of CMB is similar to that of SLI. (Circ J 2009; 73: 530 - 533)
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Vascular Medicine
  • Noriaki Kishimoto, Koichi Okita, Shingo Takada, Ichiro Sakuma, Yasuaki ...
    2009 Volume 73 Issue 3 Pages 534-539
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 15, 2009
    JOURNALS FREE ACCESS
    Background: The prevalence of obesity is gradually increasing in Japan, but in women aged in their 20 s to 50 s it has been disproportionately decreasing. However, the exact body composition of this subset of the population has not been elucidated. Methods and Results: Body composition was determined using whole-body dual energy X-ray absorptiometry and metabolic parameters in 157 Japanese female university students (21.1±1.9 years); 31 women had a normal body mass index (BMI), but an increased body fat mass (BFM). Only the 31 had significantly higher low-density lipoprotein-cholesterol levels (90.5 vs 99.0 mg/dl, P<0.01) and leptin concentration (7.0 vs 4.6 ng/ml, P<0.05) and lower high-density lipoprotein-cholesterol (80.4±15.1 vs 73.5±14.5 mg/dl, P<0.01) than females with normal BMI and normal BFM. Conclusions: A considerable number of young Japanese women with a normal BMI have excess BFM and relatively higher lipid and leptin levels. These findings may provide an important basis for future epidemiological surveys and studies. (Circ J 2009; 73: 534 - 539)
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  • Noriko Tamura, Isao Kitajima, Yota Kawamura, Eri Toda, Yu Eguchi, Hide ...
    2009 Volume 73 Issue 3 Pages 540-548
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 29, 2009
    JOURNALS FREE ACCESS
    Background: The functional links between the activation of platelets and the coagulation system have not been clarified. Methods and Results: Immobilized collagen fibrils were perfused with human blood containing fluoresceinated platelets in the presence of various concentrations of thrombin inhibitor. Coagulant activity around platelet thrombi was detected using a FITC-conjugated antibody against the fibrin monomer complex (F-405). Intra-cytosolic calcium ion concentrations ([Ca2+]i) in individual platelets and the volume of thrombi were detected with an ultrafast confocal laser microscope equipped with a piezo-motor control unit. The volume of platelet thrombi formed after 8 min of blood perfusion in the presence of 10, 25, 50, and 100 μmol/L argatroban was 7.69±0.46 μm3, 6.61±1.96 μm3, 3.63±1.54 μm3, and 1.67±0.75 μm3, respectively. There was a positive correlation between the volume of platelet thrombi and the amount of fibrin monomer complex produced around them. The [Ca2+]i of the platelets forming the thrombi oscillated between a minimum of 92.0±57.4 nmol/L, 120.1±68.1 nmol/L, and a maximum of 217.6±131.5 nmol/L, 367.6±189.1 nmol/L, respectively, in the presence of 100 and 10 μmol/L argatroban. Conclusions: The results suggest a crucial role of coagulant activity in both the generation of fibrin and the growth of platelet thrombi. (Circ J 2009; 73: 540 - 548)
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  • Noriko Inoue, Ryo Maeda, Hideshi Kawakami, Tomoki Shokawa, Hideya Yama ...
    2009 Volume 73 Issue 3 Pages 549-553
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 30, 2009
    JOURNALS FREE ACCESS
    Background: Aortic pulse wave velocity (PWV) is widely used as a noninvasive index of arterial stiffness and was used in the present study to investigate the relationship between PWV and cardiovascular mortality in the middle-aged and elderly Japanese population using a longitudinal study design. Methods and Results: From 1988 to 2003, a total of 3,960 men (50-69 years old at baseline) who underwent medical check-ups and measurement of PWV, which was standardized for diastolic blood pressure, were recruited and divided into 4 groups according to the PWV values. The average follow-up period was 8.2 years. Mortality from all-causes and from cardiovascular disease significantly increased as PWV increased in the entire follow-up period. Multivariate-adjusted relative risks of all-cause and cardiovascular disease mortality for the highest quartile of PWV (>9.0 m/s) were 1.28 (95% confidence interval (CI) 0.97-1.68) and 1.83 (95%CI 1.02-3.29), respectively, compared with the lowest quartile (<7.5 m/s). Conclusions: An increased PWV can predict cardiovascular mortality in middle-aged and elderly Japanese men. (Circ J 2009; 73: 549 - 553)
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  • Yu Eguchi, Youko Takahari, Naoko Higashijima, Nobuhiko Ishizuka, Norik ...
    2009 Volume 73 Issue 3 Pages 554-561
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: January 30, 2009
    JOURNALS FREE ACCESS
    Background: Although nicorandil has a number of beneficial cardiovascular actions, its effects on endothelial cells in the context of thrombosis have not been elucidated. Methods and Results: Arterial thrombosis was induced by endothelial injury caused by FeCl3 in the mouse testicular artery. Thrombus growth led to complete occlusion 12 min after endothelial injury in control mice. The antiplatelet agent, tirofiban, and nicorandil significantly slowed the growth of thrombi, resulting in arterial occlusion after 58 min and 55 min, respectively. In the absence of endothelial cells, nicorandil did not inhibit platelet aggregation. Diazoxide and high-dose isosorbide dinitrate both showed a similar effect to that of nicorandil. The beneficial effect of nicorandil was prevented by 5-hydroxydecanoate, but not by L-NAME. The production of reactive oxygen species by FeCl3 treatment was measured with the specific fluorescent probe, dihydrorhodamine 123. After FeCl3 treatment, nicorandil significantly inhibited the increase in fluorescence. In further experiments, incubation of human umbilical vein endothelial cells with nicorandil did not change the endothelial nitric oxide synthase (eNOS) mRNA levels, eNOS phosphorylation or nitrite production. Conclusions: Nicorandil attenuates FeCl3-induced thrombus formation in the mouse testicular artery, which suggests that it may inhibit the generation of reactive oxygen species by FeCl3-treated endothelial cells through activation of the mitochondrial ATP-sensitive potassium channels. (Circ J 2009; 73: 554 - 561)
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  • Teruyoshi Kume, Takahiro Kawamoto, Hiroyuki Okura, Yoji Neishi, Ken Ha ...
    2009 Volume 73 Issue 3 Pages 562-567
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 03, 2009
    JOURNALS FREE ACCESS
    Background: Direct measurement of plasma nitric oxide (NO) concentration is possible with a newly developed catheter-type sensor. Methods and Results: Adult mongrel dogs (n=5) were fed a high-fat diet (120 kcal · kg-1 · day-1) for 8 months, then endothelial function was assessed by the change in NO concentration induced by acetylcholine (ACh) (ΔNO). Simultaneously, average peak velocity (APV) was obtained by Doppler guide wire. Although fasting plasma glucose levels did not change after high-fat diet, fasting plasma insulin levels increased significantly (103±36 vs 106±27 mg/dl, P=0.89 and 0.15±0.15 vs 0.26±0.07 ng/ml, P=0.04, respectively). ACh-induced peak APV after high-fat feeding was not significantly different from that at baseline (ACh 0.1 μg/kg; 43±17 vs 51±7 cm/s, P=NS, ACh 0.4 μg/kg; 45±20 vs 47±16 cm/s, P=NS, respectively). The ΔNO was significantly smaller after high-fat diet than at baseline (ACh 0.1 μg/kg; 2.6±1.6 vs 1.0±0.5 nmol/L, P=0.03, ACh 0.4 μg/kg; 3.8±2.3 vs 1.8±1.1 nmol/L, P=0.04, respectively). Conclusions: In high-fat-diet-induced obese dogs NO production was impaired in the early stage when the coronary flow response to ACh may be preserved. (Circ J 2009; 73: 562 - 567)
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  • Nicoline Jochmann, Simone Müller, Claudia Kuhn, Christine Gericke ...
    2009 Volume 73 Issue 3 Pages 568-572
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 06, 2009
    JOURNALS FREE ACCESS
    Background: Smoking is the most important modifiable cardiovascular risk factor in young women. The aim of this study was to investigate whether tobacco use influences physiological changes in endothelial function during the menstrual cycle. Methods and Results: Flow-mediated dilation (FMD) and nitro-mediated dilation (NMD) were assessed in healthy smoking and non-smoking women, by high-resolution ultrasound at 3 time points during the menstrual cycle: at menstruation, in the mid-follicular phase, and in the mid-luteal phase. A total of 25 women (12 non-smokers, 13 smokers) completed the study protocol. FMD did not show differences between smoking and non-smoking women at menstruation and the mid-follicular phase. At the mid-luteal phase, however, FMD was significantly reduced in smoking when compared with non-smoking women. NMD did not differ between smoking and non-smoking women, nor between the different cycle phases. Conclusions: In healthy women, smoking eliminates the physiological amelioration of endothelial function during the menstrual cycle. This study underlines the importance of an exact description of menstrual cycle phase and smoking status in studies investigating endothelial function in premenopausal women. (Circ J 2009; 73: 568 - 572)
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Rapid Communication
  • Transparent View
    Minoru Yamada, Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Kotaro Fuku ...
    2009 Volume 73 Issue 3 Pages 573-574
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: February 03, 2009
    JOURNALS FREE ACCESS
    Background: Visualization of the inner anatomical relationship of the pulmonary veins (PVs) and left atrium (LA) is important for achieving a better success rate and avoiding complications in circumferential LA ablation for atrial fibrillation (AF). Methods and Results: Twelve patients with AF underwent computed tomography and novel post-processing images that emphasized the boundaries of the PVs and LA were produced. Conclusions: The "Transparent View" images enabled visualization of the inner anatomical relationship of the PVs and LA in the same geometry as in pulmonary venography in all cases. (Circ J 2009; 73: 573 - 574)
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Case Reports
  • A Case Report
    Nao Shimizu, Mari Iwamoto, Yukiko Nakano, Shinichi Sumita, Toshiyuki I ...
    2009 Volume 73 Issue 3 Pages 575-579
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: December 12, 2008
    JOURNALS FREE ACCESS
    We had the unique opportunity of following the electrocardiographic (ECG) course of a 13-year-old male with sinus dysfunction and atrial flutter who subsequently developed a Brugada-type ECG pattern associated with sick sinus syndrome at 25 years old. Family history showed that the patient's mother and maternal grandfather suddenly died while sleeping at night. When the patient was 13 years old, he lost consciousness after running a marathon. The patient was diagnosed with sinus dysfunction and atrial flutter, and he underwent pacemaker implantation at 15 years old. ECG examinations performed between 13 and 20 years old showed incomplete right bundle branch block and ST elevation with early depolarization. On ECG examinations performed when the patient was 21 years old and thereafter, the V2 lead always showed a saddleback-type ST elevation. At 25 years old, the late potential was positive and the electrophysiological study induced ventricular fibrillation. A challenge test with pilsicainide showed remarkable ST elevation by the V2 lead. The 24-h Holter ECG monitoring showed remarkable ST elevation after eating a snack and during night time when the patient was asleep. The patient was diagnosed with Brugada syndrome and an implantable cardioverter-defibrillator was implanted. Genetic analysis did not reveal mutation of the SCN5A gene. (Circ J 2009; 73: 575 - 579)
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  • Masayoshi Kofune, Ichiro Watanabe, Sonoko Ashino, Kimie Ohkubo, Yasuo ...
    2009 Volume 73 Issue 3 Pages 580-583
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: December 12, 2008
    JOURNALS FREE ACCESS
    A 71-year-old man with frequent ventricular premature contractions after right hip joint surgery was referred to the Cardiology Division. Twelve-lead ECG showed type II Brugada-type ECG and signal-averaged ECG showed positive ventricular late potentials. The 12-lead ECG changed to type I Brugada-type after administration of the class Ic antiarrhythmic drug, pilsicainide. Ventricular fibrillation (VF) was reproducibly induced with double premature stimuli from the right ventricular outflow tract (RVOT) at a basic cycle length (BCL) of 400 ms. Monophasic action potentials (MAPs) recorded from the RVOT at a BCL of 400 ms showed MAP alternans and VF was only induced when extrastimuli were applied after a shorter MAP of the alternans. (Circ J 2009; 73: 580 - 583)
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  • Mihoko Kawamura, Tomoya Ozawa, Takenori Yao, Takashi Ashihara, Yoshihi ...
    2009 Volume 73 Issue 3 Pages 584-588
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: December 12, 2008
    JOURNALS FREE ACCESS
    A 67-year-old male underwent genetic testing under the diagnosis of Brugada syndrome because of recurrent ventricular fibrillation with coincident ST-segment elevation in either right precordial, inferior leads or both since the age of 55 years. Screening of gene mutations using denaturing high-performance liquid chromatography (DHPLC) and direct sequencing identified a novel nonsense mutation (R179X) of SCN5A in a heterozygous manner. The functional assay for the identified mutation, using a whole-cell patch clamp in the heterologous expression system, revealed that the nonsense mutation, located in the second transmembrane segment of the first domain (DI-S2) of the α-subunit, failed to synthesize the complete structure of the cardiac sodium channel, thus causing the non-functional channel. Coding effects by the gene mutation was altered during the 12-year follow-up, which might affect the clinical features of the patient through the ion channel density in the ventricle, dynamics of repolarization abnormality and conduction disturbance. (Circ J 2009; 73: 584 - 588)
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  • Masaru Inoue, Honin Kanaya, Takao Matsubara, Yoshihide Uno, Toshihiko ...
    2009 Volume 73 Issue 3 Pages 589-592
    Published: 2009
    Released: February 25, 2009
    [Advance publication] Released: December 12, 2008
    JOURNALS FREE ACCESS
    An 82-year-old woman was admitted to the hospital due to repeated episodes of syncope with incontinence. Electrocardiography showed torsades de pointes, complete atrioventricular (AV) block, T-wave inversions and a prolonged QTc interval. Urgent coronary angiography showed no significant coronary stenosis and left ventriculography demonstrated typical abnormal wall motion of takotusbo cardiomyopathy. Electrophysiology study suggested that the damaged structure might be the bundle of His. After temporary transvenous pacing and administration of intravenous lidocaine, no recurrence of torsade de pointes was found. Symptoms of worsening heart failure were not found. Although abnormal left ventricular wall motion improved, a complete AV block remained and the patient needed pacemaker implantation on Day 18 after admission. This case demonstrated that complete AV block associated with takotsubo cardiomyopathy may persist after improvement of left ventricular wall motion, and implantation of a pacemaker may be needed. (Circ J 2009; 73: 589 - 592)
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